Organization
STODDARD EMERGENCY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(800) 893-9698
Entity
Organization
Contact information
Practice address
1200 N ONE MILE RD, DEXTER, MO 63841-1000
(573) 624-5566
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/24/2017
Last updated
08/24/2017
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